Renal replacement therapy in babies with acute and chronic renal failure

The paper summarizes the experience of renal replacement therapy (RRT): peritoneal dialysis, PD, and continuous veno-venosus hemodiafiltration, CVVHDF in 50 children under 3 years old with acute and chronic renal failure in a single center during years 2008–2009. RRT was started by PD in 13 children (26%), by CVVHDF in 37 children (74%); 22 children were treated by both methods. CVVHDF was applied more often as the «starting» method in very sick, unstable patients, while PD was used in stable patients with isolated renal failure. The complications of RRT were observed in 13 of 31 children (41,9%) on PD (dialysate leakage, peritonitis), and in 16 of 41 patients (39%) on CVVHDF (circuit thrombosis, hemorrhage). In total 10 of 50 (20%) patients on RRT have died during the acute period. The mortality rate in patients with ARF was lower in children with primary renal damage rather than in those with secondary renal failure (2 of 31, 6,5% vs . 5 of 9, 55,6%, p = 0,0012). The mortality rate in CRF was 30%. The deceased patients were younger; the rate of sepsis, multiorgan failure, and the necessity of cardiotonic support in these patients was significantly higher, and had lower arterial blood pressure than survivals. In general, both PD and CVVHDF are the effective methods of RRT in children under 3 years old. The combination of these methods allows one to treat the patients with dialysis therapy complications successfully.

дети, ОПН, ХПН, перитонеальный диализ, продленная веновенозная гемодиафильтрация, children, ARF, CRF, peritoneal dialysis, continuous veno-venosus hemodiafiltration

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